Who Is At Risk for Metabolic Syndrome?

You’re at greatest risk for metabolic syndrome if you have these underlying causes:

• A large waistline (abdominal obesity)
• Lack of physical activity
• Insulin resistance

Some people are at risk for metabolic syndrome because the medicines they take may cause weight gain or changes in blood pressure, cholesterol, and blood sugar levels. These medicines are most often used for inflammation, allergies, HIV, and depression and other kinds of mental illnesses.

Populations Affected

About 47 million adults in the United States (almost 25 percent) have metabolic syndrome. Metabolic syndrome is more common in African American women than in African American men and in Mexican American women than in Mexican American men. It affects White women and men roughly equally.

Some racial and ethnic groups in the United States are more at risk for metabolic syndrome than others. Mexican Americans have the highest rate of metabolic syndrome (31.9 percent). Caucasians (23.8 percent) and African Americans (21.6 percent) have lower rates.

Other groups that are at increased risk of developing metabolic syndrome include:

• People with a sibling or parent with diabetes
• People with a personal history of diabetes
• Women with a personal history of polycystic ovarian syndrome (a tendency to develop cysts on the ovaries)

In addition, members of certain ethnic groups are at increased risk for metabolic syndrome. For example, South Asians have an increased risk for metabolic syndrome.

Risk for Heart Disease

Having metabolic syndrome increases your risk for heart disease. Heart disease risk can be divided into short-term risk (the risk for having a heart attack or dying of heart disease in the next 10 years) and long-term risk (the risk for developing heart disease over your lifetime).

Other factors (aside from metabolic syndrome) contribute to your risk for heart disease as well. The major risk factors are:

• Increased LDL cholesterol (low-density lipoprotein cholesterol) and total cholesterol levels. (LDL is the “bad” cholesterol.)
• Cigarette smoking.
• Blood pressure that is greater than or equal to 140/90 (or you’re on medicine for high blood pressure).
• Decreased HDL cholesterol (high-density lipoprotein cholesterol) level to less than 40 mg/dL. (HDL is the “good” cholesterol.)
• Age (for men ages 45 and older and for women ages 55 and older).
• Family history of early heart disease or sudden death (in a father or brother before the age of 55, or in a mother or sister before the age of 65).

If you smoke cigarettes or have increased LDL cholesterol or high blood pressure, these are the first targets of treatment.

Regardless of whether you have metabolic syndrome, you should find out your chance of developing heart disease in the next 10 years (your short-term risk). This will help decide what your LDL cholesterol goal should be and how you should be treated. To start, you will need to count how many risk factors you have from the list above. (Don’t count LDL and total cholesterol because the treatment for them will be geared to your level of risk.)

The National Cholesterol Education Program (NCEP) divides short-term heart disease risk into four categories, as shown below. Your risk category depends on the number of risk factors you have and which ones they are.

Your risk factors are used to calculate your 10-year risk of developing heart disease. The NCEP has an online calculator that you can use to determine your 10-year heart disease risk score. Every person with metabolic syndrome should have their 10-year-risk score calculated.

• You’re in the High Risk category for heart disease if you already have heart disease or diabetes, or if your 10-year-risk score is more than 20 percent.
• You’re in the Moderately High Risk category if you have two or more risk factors and your 10-year-risk score is 10 to 20 percent.
• You’re in the Moderate Risk category if you have two or more risk factors and your 10-year-risk score is less than 10 percent.
• You’re in the Lower Risk category if you have zero or one risk factor.

Even if your 10-year-risk score isn’t high, over time metabolic syndrome will increase your chance for heart disease. This means that, regardless of your short-term risk category, metabolic syndrome should be treated (mainly with lifestyle changes).